Coda Change

This presentation was delivered by Greg Kelly as part of the Clinical stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

Mya Cubitt and Jeremy Pallas answer questions from the audience at the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

Ben Medley and Luke McDonald answer questions from the audience at the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

Yolanda Coleman and Nilru Vitharana discuss a paediatric trauma case study. This Panel took part at the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Virginia Newcombe as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation was delivered by Kate Jordinson & Loren Gallagher as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/

This presentation was delivered by Nilru Vitharana as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This Q&A features Dr David McCreary, Dr Jennifer Jamieson, and Associate Professor Joseph Matthews. It took place as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

Oli Flower sits down to talk with Penny Stewart, an intensivist working in Alice Springs, to discuss the upcoming "Together Outback: Hearing the Outback Voices in Healthcare" conference.

Music credits: Spinifex Gum - The Children Came Back. Listen to the full track.

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Together Outback: Hearing the Outback Voices in Healthcare

20-21 June, 2024 | Alice Springs Limited free tickets available. Book now to confirm your place!

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Together Outback: Hearing the Outback Voices in Healthcare is a unique conference looking at the challenges of critical care in the rural and remote setting. The need to adapt to the environment, the resources and our patients. How adaption drives the need for innovation and advocacy to build strong critical care in remote Australia.

Get ready to be inspired as renowned journalist and Indigenous affairs expert, Stan Grant, takes the stage to share his unique insights on healthcare disparities and   the importance of hearing marginalized voices. With his thought-provoking perspectives, Stan Grant will challenge the audience to think critically about the current state of healthcare and its impact on First Nation communities.

But that’s not all.  “Together Outback” goes beyond one speaker, providing a platform for numerous   respected doctors and healthcare professionals to share their experiences and expertise. These esteemed individuals will shed light on the challenges faced by  clinicians delivering critical care in regional and remote Australia, as well as the unique challenges faced by Indigenous communities, and discuss innovative  approaches to bridging the healthcare gaps.

This event is a must-attend for anyone in the healthcare industry who wants to gain a deeper understanding of the issues   faced by First Nation Peoples. The insights shared by the speakers will provide valuable knowledge and tools that can be applied to improve health care practices.

Through a professional and compelling tone, this event aims to raise awareness and spark meaningful discussions about  healthcare inequalities. Attendees will have the opportunity to engage with like-minded professionals, exchange ideas, and contribute to the ongoing dialogue on improving healthcare for all.

Prepare to be captivated by the stories, ideas, and solutions presented at “Together Outback: Hearing the Voices in Healthcare.” By attending, you’ll be part of a transformative event that will leave a lasting impact on your understanding of healthcare disparities and the importance of inclusivity in the field. Don’t miss out on this unique opportunity to be part of the conversation.

*This event is funded by the Commonwealth Department of Health’s Specialist Training Program (STP)

For more information, go to: https://intensivecarenetwork.com/together-outback-the-free-conference-you-must-attend/

This presentation was delivered by Yolanda Coleman as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Luke McDonald as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Ben Medley as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Mya Cubitt as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Dinesh Palipana as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Jeremy Pallas as part of the Trauma Updates Workshop at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Karin Thursky as part of the Cure stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Fiona Gray as part of the Cure stream at CODA22, which took place in Melbourne in September 2022. 

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Simon Finfer as part of the Cure stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Madiha Hashmi as part of the Cure stream at CODA22, which took place in Melbourne in September 2022. Features introduction from Naomi Hammond and Brett Abbenbroek.

For more information about the CODA Project go to: https://codachange.org/ 

This Q&A is moderated by Greg Kelly and features Dinesh Palipana, Marnee Shay, Jess Stokes Parish, Clara Tuck Meng Soo, Maya Newell, and Eve Purdy. It took place as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Maya Newell as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Marnee Shay as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Clara Tuck Meng Soo as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Jess Stokes Parish as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Dinesh Palipana as part of the Educate stream at CODA22, which took place in Melbourne in September 2022.

This podcast features an introduction by Greg Kelly.

For more information about the CODA Project go to: https://codachange.org/ 

This Q&A features Emily See, Carol Hodgson, and Caleb Fisher, and took place at the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This Q&A features Chaturi Dissanayake and took place at the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This Q&A features Panka Jain and took place at the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This Q&A occured between various speakers from the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Caleb Fisher as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Carol Hodgson as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Chaturi Dissanayake as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Toby Jeffcote as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Panka Jain as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project go to: https://codachange.org/ 

This presentation was delivered by Luke Torre as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Emily See as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Charlotte Harper as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Elliot Long as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Warwick Teague as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This Q&A was part of the the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022. It features Fran Lockie, Jackie Schultz, Alison Boast, and Tony Norris

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Tony Norris as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Alison Boast as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was delivered by Jackie Schultz as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

This presentation was presented by Fran Lockie as part of the Acute Paediatrics Workshop at CODA22, which took place in Melbourne in September 2022.

For more information about the CODA Project, go to: https://codachange.org/

You may have noticed that the last couple of podcasts we've published were neuro-related talks that were recorded at the BRAIN Symposium which took place earlier this year.

If you want more neurocritical care podcasts make sure to head over to the NeuroResus channel. Over the coming months we’ll be publishing more talks from the BRAIN Symposium around neurocritical care,  neuro resuscitation, and neuro emergencies.

Subscribe to Neuroresus in your preferred podcast app, or sign up to the Neuroresus newsletter to receive updates directly in your inbox.

Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. 

This podcast was recorded at the Brain Symposium which took place in March 2023. For more talks and content like this, visit neuroresus.com. 

Social Worker Victoria Whitfield and Bereavement councilor Louise Sayers discuss the power of words when health professionals are communicating topics around of death and serious injury with relatives and patients in critical care. They use role plays to bring theories to life. 

This podcast was recorded at the Brain Symposium which took place in March 2023. For more talks and content like this, visit neuroresus.com. 

Ambulance Victoria has committed to become a more sustainable ambulance service. This includes achieving net zero emissions five years prior to the Victorian State Government commitment of 2050 with additional emissions reduction targets for 2025 and 2030. By fulfilling these targets, the carbon footprint for each patient cared for by Ambulance Victoria will be halved by 2030. It is apparent that to meet these emission reduction targets, Ambulance Victoria's current model of care needs perpetual refinement. Reducing emissions from electricity and fleet start to look easy in comparison to reducing low value care. Delivering better care to a patients according to their particular healthcare needs suggests that our pre-hospital service needs to be reimagined to start prior to any patient picking up the phone to dial Triple 000. Ambulance Victoria are discovering new ways to offer best care for particular patient cohorts via new technologies such as telehealth and the Virtual ED and by partnering across our communities primary and secondary healthcare networks, to offer timely support to those for whom an ambulance doesn't offer the greatest benefit. In 2021, Ambulance Victoria undertook a study to map the carbon pollution associated with its Triage Services and measure changes in carbon pollution resulting from the use of alternate patient care pathways. The analysis revealed interesting results that have implications for pre-hospital service design in the future. We hope that this study offers insight into new ways of thinking for decision makers and enables a triple bottom line approach to assessing the benefit of programs and keeping an awareness of how to serve the community in more environmentally sustainable ways. Using a multipronged approach to improving healthcare sustainability at Ambulance Victoria can reduce the environmental impact of pre-hospital healthcare services and thereby minimise the health impacts from the sector that are associated with dangerous climate change.

CODA Change and Sustainable Healthcare. Climate change is a pernicious environmental and health threat to humanity. Yet, healthcare itself pollutes, contributing to approximately 5% of total global anthropogenic emissions. What can be done to avoid this harm? Forbes McGain has spent 15 years undertaking research with colleagues to discover healthcare’s environmental footprint, with a particular emphasis upon practical efforts to reduce this environmental and economic burden. In this discussion we will hear of a series of micro, meso, and macro actions that each can contribute to reducing our carbon and other environmental footprints at work. Mico: all clinicians have agency to avoid, reduce, reuse, and if none of these are possible, recycle. Further, efforts to provide excellent primary care such as preventing obesity, diabetes, and drug harms, and delivering vaccinations are integral to ameliorating healthcare’s environmental footprint. From titrating oxygen on the hospital wards to deliver enough, but no more for patients, to undertaking antibiotic stewardship (and switching from i.v. to oral preparations) there are actually many daily activities in healthcare that could reduce our environmental footprint whilst delivering ongoing safe patient care. Meso: Collaboration is the key here! There are many low carbon healthcare activities that cannot be ameliorated without teamwork, for example at the GP clinic, hospital ward, or operating theatre level. A good example within hospitals are efforts to convert single use to reusable equipment. Although evidence is presented of the economic and environmental benefits of reusable anaesthesia equipment such information (and publications) has not lead to widespread adoption of such approaches. The importance of champions in each hospital and collaborating with clinical and non-clinical colleagues in hospitals is emphasized. Forming hospital environmental sustainability committees, and alliances with hospital executives and the board is vital. Macro: Advocacy at the medical and nursing societal and colleges level to incorporate environmentally sustainable healthcare into routine clinical education, examinations, and research agendas is the work of concerted groups of clinicians. Influencing the various state, territory and national governments to develop/extend sustainable healthcare units will likewise form part of macro efforts. Joining the Doctors for the Environment, Australia (DEA), activating the ANMF and AMA to get involved in environmentally sustainable healthcare will augment such efforts. Full Sails on Our Journey!

Climate change is now our lived experience. With no vaccine to reduce its impact on health, the only preventative strategy we have is to reduce emissions, including healthcare delivery. The greatest portion of healthcare’s emissions profile comes from the stuff we use, so we have to change what we do. But how?

Decarbonisation on the clinical floor is a look at every day work activities. It is bridging the gap between abstract concept and service delivery. It comes with triple bottom line wins – people, planet, and profit.

The future isn’t written yet. The things we do now are what make it. We have choices to make that matter. We need visionaries to show us the direction. We need practical examples that bridge the gap between ambition and action. We need to tell the climate story in a way that draws people in, that empowers them to take action and enables us to be part of the solutions.

Nick Watts

In today’s podcast, Nick Watts - chief sustainability officer at the NHS speaks about why - when the NHS says there are three things they want to implement over the next decade - their response to climate change is number two.

Watts explains that they understand the health implications of a rise in temperatures, they understand that it means a doubling of the number of high risk health facilities in flood zones, and a tripling of the average duration of fatal heatwaves and notes that they saw what that looks like for our healthcare system.

He talks about how while the average across a summer the UK face 2200-2400 excess deaths from heatwaves; the recent six-day heatwave saw 12800 deaths – six times the usual amount. That’s why the NHS cares deeply about this.

If the climate crisis is a healthcare crisis, Watts says that it’s important to face it head on. Principally, he says, acute care is responsible for the NHS’s emissions, while primary care also comes in strong due to its prescriptions and medicines.

He discusses how in order to cultivate real change, you don’t just run at one small part – turning off the lights and turning the temperature down simply isn’t enough - you need look at every single emission you can possibly think of. For the NHS it means net zero by 2045.

NHS reports publicly to both their board and 1.4million NHS professionals every single year. Watts says that it hit first year emissions target; he promises they’re going to hit their second. It will, however, start getting hard to hit their targets from year 5 onwards.

Transparency is critical. Milestones and scope need to be clear.

Watts explains that from 2027 onwards the NHS will no longer purchase from anyone that does not meet or exceed their commitments to net zero.

He says that while the NHS will do absolutely everything in their power, they can’t run at this alone. The challenge is too big, medicine is too complex. Thankfully the NHS isn’t alone. 14 other countries followed suit in committing to reaching net zero.

To end, Watts insists that it’s when other people take note, start taking this seriously, and when other healthcare systems start to engage that net zero stops becoming possible, and starts to become inevitable.

Sepsis in other words ‘life-threatening organ dysfunction’ in response to infection is a leading cause of death worldwide and a global health priority recognised by the World Health Organisation. In Australia, for adults with sepsis admitted to the intensive care unit, the in-hospital mortality is estimated as 18–27%. Early recognition of sepsis, prompt administration of antibiotics and resuscitation with intravenous fluids for those with features of hypoperfusion or shock are the mainstays of initial treatment. Emergency departments often being the first point of contact for patients presenting with sepsis, are required to prioritise sepsis as a medical emergency. The “Sepsis Kills” program implemented across the nation aims to reduce unwarranted clinical practice variation in management of sepsis.

In a recent Australian based study conducted across four emergency departments in Western Sydney Local Health District, among 7533 patients with suspected infection, a reduction in risk of in-hospital mortality was observed for each 1000 mL increase in intravenous fluids administered in patients with septic shock or admitted to ICU. However, despite evidence showing mortality benefits, not all aspects of sepsis care have been given the needed attention. In the same setting, out of 4146 patients with sepsis, 45% of them did not receive intravenous fluids in the emergency departments within the first 24 hours. Younger patients with greater severity of illness and presented to smaller hospitals were more likely to receive fluids. 

The unanswered questions regarding the facilitators and barriers influencing intravenous fluid administration in sepsis are being explored using qualitative methods. Several emergency physicians and nurses have provided insight into aspects that influence their ability to provide appropriate fluid resuscitation such as constantly overcrowded emergency departments with chronic staff shortages of skilled health professional, failure to recognise sepsis early, the complexity of the presentations and lack of resources. Awareness of these challenges among stakeholders is the need of the hour. Leaving no one behind and not disregarding the critical aspects of sepsis care are crucial. Recognition of these factors and sustainable interventions are necessary to improve clinical outcomes for patients.

For more head to our podcast page #CodaPodcast

Physiotherapists form a key part of the multi-disciplinary team in the Intensive Care, focusing on both respiratory care and optimisation of function. This talk will discuss the role of physiotherapy across the continuum specifically in the management of an acutely unwell septic patient. I will discuss the focus of a physiotherapy assessment, main treatment aims, some of the barriers for the implementation of physiotherapy in ICU, while identifying strategies to enable appropriate application of physiotherapy techniques.

For more head to our podcast page #CodaPodcast

Sepsis is a common presentation in the prehospital and retrieval environment, with most cases having a respiratory, urinary or soft tissue origin. However the best practice for identifying and management sepsis in the prehospital environment remains unclear.  Despite sepsis having been a priority for in hospital guidelines and protocols for decades now, relatively little attention has been paid to prehospital sepsis management. Traditional teaching is that early antibiotics in sepsis save lives, however trials examining this are observational and confounded by outdated ICU care. An appropriately sensitive and specific tool for the prehospital identification of sepsis remains elusive. NEWS2 is common and lactate-modified QSOFA emerging (although prehospital lactate measurement remains difficult). The role of prehospital antibiotics, and the most appropriate one are also unclear. Most ambulance services that carry antibiotics use ceftriaxone. The retrieval environment is similar, with sepsis probably being the single commonest reason to call a retrieval service.

For more head to our podcast page #CodaPodcast

As part of the Sepsis Workshop, this presentation will briefly touch on the challenges that patients and their families face on discharge from hospital after an admission for sepsis. 

For more head to our podcast page #CodaPodcast

As an ICU registrar you meet septic patients at different points in time: as the first responder, asking ‘could this be sepsis?’; as the second responder, admitting the patient to the ICU; or the third responder, having to consider adjuncts in the deteriorating patient. Each of these presents different challenges and learning experiences, making the reality of managing sepsis more complex than one might first expect.

For more head to our podcast page #CodaPodcast

As with everything else, ICU management of sepsis should ideally the evidence based. Evidence based practice combines the best scientific knowledge (evidence) with patient preferences and clinical assessment and judgement.

While the pursuit of specific pharmaceutical agents to treat Sepsis has resulted in the expenditure of billions of dollars without producing a single effective agent, much of what we do in the treatment of patience with Sepsis can be evidence based. Clinicians make literally hundreds of decisions day on the management of an individual patient in the ICU, often these decisions are made routinely without a great deal of thought about the reasoning behind them. Every decision made about the treatment of a critically ill patient should be based on evidence or the belief that the action resulting from that decision will improve a patient centred outcome for that particular patient. A patient centred outcome is an outcome that affects how the patient feels, functions or survives meaning we should question every decision we make to ask whether it is going to improve one of those outcomes.

The best evidence on which to base of such decisions comes from large robust randomised controlled trials conducted by unbiased investigators. The last 20 years has seen the emergence and maturing of regional and national clinical trials groups who conduct such studies and increasingly collaborate with each other. (2) Such collaboration is often essential to perform studies large enough to provide evidence to guide clinical practice such collaboration is often essential to perform studies large enough to provide evidence to guide clinical practice. As someone who designs and contacts clinical trials I am well aware that they provide evidence on a population basis. Each trial result is the net of harm and benefit resulting from the treatment being studied and even when a treatment is proven to have a net benefit there may be some patients who are harmed by the use of that treatment. A graphic example of this is someone who suffers a massive intracranial haemorrhage when treated with thrombolysis. Causing visible harm to a patient may shake a clinician's faith in an effective treatment making it important that we accept such tragic events without changing our practice to deny that effective treatment to future patients.

Research, like clinical practice, has inherent imperfections. Researchers, like clinicians, need to recognise this and be prepared to put their hand up and admit when they have been wrong. Conducting robust studies of appropriate size in an effective collaborative research group is the best way to avoid being wrong too often!

For more head to our podcast page #CodaPodcast

Sepsis causes organ and tissue dysfunction in response to severe infection, resulting in significant physical and cognitive morbidities. For patients diagnosed with severe sepsis, admission to an intensive care unit and use of an artificial airway are often required. The sequalae of severe sepsis necessitating critical care can result in significant changes to a patient’s swallowing and communication function. These negative changes and impacts to function can occur during and after a diagnosis of sepsis, and ultimately impact a patient’s health and functional status. The nature and long-term recovery of swallowing and communication function is still to be completely understood; however evidence affirms recovery continues well beyond hospital discharge.

This presentation will focus on tasks we do daily – eating, drinking and speaking. Specifically, the nature of swallow impairments will be described, and the impact of this new disability will be explored from the perspective of the patient’s body structure, function and activities. Core components of swallowing safety and efficiency will be described, alongside the role of assessment and management within and beyond the ICU. Changes to communication including altered voice, speech and language function will be described. Outcomes of altered communication function over the continuum of care during, and after hospital will be explored. The evidence base and the lived experience of sepsis and patient stories will underpin the content delivered in this presentation.

The final aim of the presentation will be to describe and highlight the role of speech pathology, an allied health profession, in the management of swallowing and communication function. Following the workshop attendees will be able to (1) describe the characteristics of swallowing and communication disorders; (2) have knowledge of the impact of these new disabilities; and (3) will be able to describe the role of speech pathology in the healthcare team for the patient with sepsis.

For more head to our podcast page #CodaPodcast

Dr Greg Kelly – a paediatric intensivist at Westmead Children’s Hospital – is today’s guest, on the #Coda22 podcast, during which he discusses a little girl called Abbie, who has lived in ICU for almost two years, and how she represents a very important group of patients – who are a tiny fraction of admissions, but a huge proportion of the workload at Westmead Children’s Hospital. Such patients are complex in such a way that no-one knows exactly what to do with them; nor how to respond to them. He goes on to discuss the problems they see every day at Westmead Children’s Hospital, and what the practitioners can do about them.

This session presents a series of medical cases with important clinical caveats. Additionally, a contextual discussion follows, focussing on the social determinants of health and their integral importance in delivering high quality care. The practice of acute medicine requires many skills to ensure the delivery of the highest quality care. Clinical knowledge and skill are essential, but equally communication, empathy, social/cultural awareness and advocacy are also vital. Knowing our patients and understanding their circumstances provides a foundation on which clinical practice can then be contextually applied. Without context raw facts can be misleading and even result in misdirected treatment plans.

In this week’s episode of the #CodaPodcast, Gemma Figtree – a Cardiologist and Professor discusses the profound inequality of gender issues.

In this week’s episode of the #CodaPodcast, Dr Daniel Nour – who founded Street Side Medics a not-for-profit, GP-led mobile medical service for people experiencing homelessness - in August 2020 talks about his grave concern for the homeless who have gone untreated for years. He talks about how it was seeing the inequality in healthcare among the homeless that made him want to do something about it and how we often think about their need for shelter and food, but not for suitable healthcare.

He also discusses the barriers that face homeless people and what it was that led him to launch Street Side Medics.

There is a moment that regularly occurs in the life of a clinician working at a major trauma service - where a rotating registrar, a keen sponge - appears, and a discussion about learning goals for the rotation is had. Its always about trauma, I'm here to learn procedures, intercostal catheter insertion, thoracotomies etc etc and if there is a trauma call, I'd love to be involved. But when I point to an older woman in the corner who has fallen from standing height, suggesting that perhaps we start our trauma education there, there are looks of confusion, annoyance even. This patient doesn't fit their expectation of what trauma physician needs to learn. But a trauma physician's paradigm, must evolve.

Healthcare Saves!

Healthcare Pollutes!

Healthcare is responsible for 7% of Australia's carbon emissions, consumes 10% of Australia's GDP, and has numerous other adverse environmental effects.

In this talk, Forbes McGain, an anaesthetist and intensive care physician, introduces healthcare's polluting ways, and how clinicians can mitigate their own carbon footprint. Action is the Antidote to Anxiety!

For more head to our podcast page #CodaPodcast

The chair, Kate Charlesworth opens by explaining that the healthcare system has a big problem – we are, in effect, producing our own patients. We use huge amounts of resources; produce vast amounts of waste and have a big carbon footprint. Globally, if the healthcare system was a country, it would be the fifth biggest polluter on the planet. The irony is then of course that we’re therefore contributing towards the climate crisis which is harming human health. We’ve seen that with storms, fires, floods, and all the associated impact they’re having on our health.

We have a huge job ahead of us – to decarbonise or to get to a net zero health system.

Nick Watts, doctor, and chief sustainability office for the National Health Service in England says that he wants to discuss three things: why the NHS cares about climate change, what we can do about it and exactly what that change needs to looks like. He then goes on to explain the steps that the NHS is taking to reach net zero by 2045, and the exact steps that we need to take in order to do the same.

His three key messages are:

The climate crisis is a health care crisis.

The time for talking about stuff is over, the only thing that matters is what we are going to do about it.

Don’t listen to anyone that tells you that it can’t be done.

For more head to our podcast page #CodaPodcast

Beyond Zero Emissions is an independent think tank that shows through research and innovative solutions how Australia can prosper in a zero-emissions economy. Over the past 10 years we have published research on how to decarbonise sectors of the economy such as energy, transport, buildings and heavy industry.

Healthcare is a significant energy consumer - around 7% of national emissions come from healthcare facilities and services. Within this important sector, energy use holds the most emissions reduction potential, while manufacturing has the strongest ‘multiplier effect’ - the ability to deliver widespread benefits from decarbonisation.

We can power our healthcare sector on 100% renewable energy right now.

Energy is used in health facilities for heating water, air, running medical equipment and keeping the lights on. It is also used in vehicles transporting supplies, patients and staff. With clean technologies available now, e.g. heat pumps and electric vehicles, there are readily-available means to run our healthcare system with renewable energy.

We can power our manufacturing sector on 100% renewable energy right now.

We know what happens when global supply chains are disrupted. A strong onshore manufacturing sector is not only important for a zero-emissions economy, but for all Australian industries - including healthcare. Today, imports meet approximately 80% of domestic demand for medical devices and diagnostics, while nearly all medical technology products manufactured in Australia are exported.

When our healthcare system can source more of its construction materials, products and equipment from local suppliers, we shorten supply links, speed up transport time and provide more onshore jobs supporting this sector.

Beyond Zero Emissions is working with partner organisations around Australia to revitalise our manufacturing sector with 100% renewable energy. We’re building alliances of industry, government and community to support the decarbonisation of local manufacturing and supply chains in regional hubs where it’s needed most.

Resilience for healthcare depends on resilient energy and manufacturing supply chains - and achieving that means more renewable energy powering our economy.

For more head to our podcast page #CodaPodcast

Each speaker delivers a short high impact clinical case from practice ranging from conflict zones to 2 week boarding in the emergency department in India. These cases have been chosen because of the profound personal impact upon the clinician. Following the clinical cases, Ben will facilitate a debrief to explore how these clinicians prepared for, performed in, or recovered from the situations.

Ankur Verma opens the podcast by telling his listeners that he’s going to share with them something that happened during the time that Delta was in its dreadful stages in both Australia and India.

He goes on to talk about a case that took place during the Delta wave, when minutes matter. He recounts a patient - Mrs P - who had come in gasping and immediately went into cardiac arrest, and notes that – as is often the case – she immediately became part of the ward’s family. After testing positive for Covid, they then gave her a CT scan to see if she had pneumonia and subsequently put her on various experimental medications, including steroids.

She got better over the next four or five days and was weaned off the ventilator and over the next couple of days we removed her TPI (trigger point injection) but then her sugars went up. Ankur explains that just when he thought she was becoming much better, she started becoming hypoxic again and he then found out her left lung had collapsed.

She then went on to improve – and, understandably – her family were thrilled, especially her son. After a two-week rollercoaster ride, she was discharged, much to the joy of everyone involved.

At a time of great distress, Ankur explains that Mrs P reminded him and his co-workers of the power of determination and motivation, and it was through a combination of compassion and great determination and motivation that she survived.

He notes that Mrs P gave the hospital staff a ray of hope and a much-needed silver lining during what was an otherwise hellish Covid wave, and notes that he owed her more than she owed him for saving her life.

But, continues Ankur, she had other plans. She had been a ray of hope during the dreadful delta in India and the world and sadly, she died.

But Ankur says that he and his co-workers didn’t lose sight of the vision and the hope that she gave them and that they continued to support each other. He concludes the podcast with an important lesson learnt: take care of yourself and those around you because when the dark times come, those people will be the ones surrounding you.

For more head to our podcast page #CodaPodcast

Bec Szabo – an obstetrician, gynaecologist, and medical educator – begins the podcast by asking the audience to go back to Melbourne with her on a journey through the looking glass. She notes that while taking her listeners to Wonderland might be a bit quirky, but that it’s essential for the point of the story. Bec also wants to preface the talk with a trigger warning; and acknowledges that the subject matter of her talk might be triggering – so please do bear in mind that this talk covers Covid, ICU and pregnancy before listening.

As per the notion of taking her readers through the looking glass, Bec wants to take listeners back to spring 2021 – a time that Melbourne was looking down the barrel of a sixth lockdown. Known as having had one of the longest – and strictest – lockdowns in the world - people in Melbourne were tired and had done a lot. Many were already vaccinated.

Bec then goes on to say that she wants to talk about Covid and pregnancy and, explains to listeners that she wants to paint a picture of inequality and sexism.

She runs through a case of what happened shortly after the Delta strain had arrived in Melbourne – it was a time when things were changing rapidly during covid with delta things came thick and fast. A pregnant woman was admitted to hospital; it was her third child, and her two toddlers, partner and parents were all sick with Covid; and despite concerns over a post-partum haemorrhage, a healthy baby was delivered, and the woman went back to the ICU.

Except, says Bec, this wasn’t what actually happened; what she described was a simulation, carried out in order to ensure they had everything prepared in the case that something similar happened.

She goes on to say that teamwork and communication are everything, but so too is listening to the voice of the patient. And that while we’ve heard that belonging and community and connection are important, having those values and shared goals to keep us doing what we’re doing.

Bec closes the podcast by that we need to remember we’re the captains of our soul. And that if we can be human and kind, we can deal with emotionally fraught situations.

For more head to our podcast page #CodaPodcast

In this week’s podcast Liz Crowe – an advanced clinician social worker who has worked in Brisbane’s major children’s hospitals in intensive care, emergency departments and cancer wards - begins the podcast with the question – is all this talk of burn out, actually making us burnt out?

In this podcast, Liz goes on to address exactly what the term burn out actually means and discusses how the literature on burnout in healthcare workers is prolific. She discusses how healthcare presents as an occupation of high risk, distress, and despair, with an escalation of risk post pandemic. Yet, she says, burnout is not the whole story even though it is the only story being told. Liz speaks about the extensive research into burnout and what it reveals, and the risk factors for burnout, which include excessive workload, lack of control or recognition, mismatch of values, lack of meaning and emotional contagion. However, she notes that none of these are individual deficits and says that it is concerning that ‘wellbeing’ in healthcare is never discussed in terms of meaning making, purpose, contribution, community, stimulating work or growth and development.

Yet, she goes on to say, for many critical care staff these positive factors for wellbeing are found in abundance.

Liz also states that her research shows that people want to believe that the bad stuff happens on one side of life; the good on the other, and people want to know how they get to the other side. Whereas, she says, in reality, life is a crappy mess that sits somewhere in the middle.

The podcast concludes with Liz stating that purpose and community are everything, that life is messy, but some days - despite how awful we feel - we soar because of the opportunities we have. She encourages listeners to savour life, and to remember that even on the worst day of their working life, their patients are doing it tougher.

For more head to our podcast page #CodaPodcast

"Death is not the enemy but occasionally needs help with timing." Peter Josef Safar (1924 – 2003) 'The Father of Modern CPR'

In this week’s episode of the Coda podcast, former flight paramedic Gary Berkowitz – who previously worked in Afghanistan and now works for Queensland Ambulance Service - explores how when death is inevitable, the way of dying matters.  

To open the discussion, he addresses the fact that out of hospital emergency care practitioners are often faced with time critical decisions. He notes that fortunately, most of these situations often have clear guidelines because – generally speaking - they follow pathways with expected outcomes.

When it comes to ethics in healthcare, however, it can be a nuanced topic. For example, the decision to not commence resuscitation, or to withdraw life saving measures in a patient who appears to have no meaningful prospect of recovery, can be a difficult one. Gary goes on to note that in this environment, it’s impossible to design a guideline that could encompass all the elements of such a complex decision.

In this talk Gary examines providing care to patients rather than always trying to fight death. By way of example, Gary tells listeners how he was working closely with the various western military forces, when one day they asked a favour – a young Afghani soldier had been badly burnt fighting against the Taliban, and while his treatment had begun in a military hospital, it was decided it shouldn’t be continued there.

Gary was asked if he could assist transporting the soldier to a hospital in the city, and he goes on to talk about the fact that he had two options – to take the easy choice, which would have involved giving the soldier enough medication that he wouldn’t have to see him suffer; or the brave choice – which would have been to give him enough medication so he wouldn’t be suffering at all.

He discusses the ethics around each alternative – and how he came to sit with his final choice. Gary notes that the decision he made that day has remained with him ever since, and continues to influence his decisions in his everyday practice.

For more head to our podcast page #CodaPodcast

Working in medicine presents truly testing challenges for anyone. Adding the uncertainty that comes with autism can take these challenges to new heights. So how do those with autism break down the barriers of their diagnoses to become effective members of the healthcare community? And are there benefits to having such a unique mental approach to tasks?

HEALTH & WELLBEING SPECIALIST LIZ CROWE SITS DOWN WITH CANDICE CARLISLE – A NURSE IN THE ACUTE PAIN SPECIALTY TEAM WHO ALSO HAS AUTISM. CANDICE ADDRESSES THE ASSUMPTIONS, CHALLENGES & UNEXPECTED BENEFITS OF BEING AN AUTISTIC MEMBER OF THE HEALTHCARE WORKFORCE.

Candice begins by recognising the key role that autism plays in shaping her identity, and the importance of not shying away from her diagnosis. In saying this, she also affirms that having autism does not define who she is. Having two children with autism, Candice also ensures that they embrace the condition and see it as a good thing.

CANDICE GOES ON TO EXPLAIN HOW THOSE WITHOUT AUTISM CAN “DO THE RIGHT THING” WHEN ADDRESSING THOSE WITH THE CONDITION.

“For me, just knowing that people have the knowledge,” “…that’s fantastic.” Candice states that recognising autism within conversations and acknowledging the differences in a positive, open-minded light is helpful.

LIZ DIRECTS THE CONVERSATION TO CANDICE’S CAREER AS A NURSE AND HOW HER AUTISM AFFECTS HER WORK.

Candice concedes that the changes brought about by Covid were very difficult to deal with due to her reliance on routine. Different autism-specific anxieties make accepting change very difficult. Despite this, Candice explains that there are unexpected benefits to having autism in her line of work – the standout ones being attention-to-detail and situational awareness. She also explains how mechanisms like mimicry & masking can help autistic people cope in many areas of work and life.

THE PAIR CONCLUDE BY DISCUSSING THE IMPORTANCE OF SUPPORT FROM THOSE WHO DON’T HAVE AUTISM, PARTICULARLY IN THE WORKFORCE.

Tune in to this unique, insightful take on autism with Liz Crowe & Candice Carlisle.

Breaking Barriers: Working in Healthcare with Autism

For more like this, head to our podcast page. #CodaPodcast

Health care constitutes 7% of Australians domestic carbon footprint with hospitals and pharmaceuticals being responsible for almost 2/3rd of these emissions.

We can reduce this carbon burden by addressing our practice habits, taking emissions into account, while achieving best practice care.

Three areas where we can really make a difference are in pathology ordering, asthma management and anaesthetic gases. In each of these, low carbon practice also constitutes good clinical practice, making climate action a win for emissions and a win for our patients.

In this recorded After Hours Webinar presented by Kate Wylie, Dr Roger Harris presents the excellent work that Coda Change is doing to address these three climate actions.

Dr Harris is a co-founder of Coda and a senior staff specialist in the intensive care unit at the Royal North Shore hospital and the Sydney Adventist hospital (SAN). He is dual qualified in Emergency Medicine and Intensive Care and is passionate about education and climate change.

This is a recorded version of an After Hours webinar.

For more like this, head to our podcast page. #CodaPodcast

“5 THINGS YOU CAN DO TO SAVE THE PLANET” with Hugh Montgomery (w. Liz Crowe)

SCIENTIST & CLIMATE EXPERT HUGH MONTGOMERY DISCUSSES THE CONCERNING STATE OF THE PLANET & OUTLINES WHY WE NEED TO BEGIN TAKING REAL, IMMEDIATE ACTION TO SAVE IT.

In this chat with wellbeing specialist Liz Crowe, Hugh begins by addressing the satirical Netflix film “Don’t Look Up” and pointing out that it may not be as far from reality as people think. We’ve been sitting on our hands & ignoring warnings in terms of greenhouse gases for too long, and Hugh warns that the “asteroid is about to strike”.

HUGH CITES REPORTS WHICH CLAIM WE HAVE JUST A FEW YEARS TO TURN AROUND THE CLIMATE CRISIS. HE DETAILS WHAT COULD HAPPEN IF THINGS DON’T CHANGE.

Extreme weather will be one of the most notable signs. Global sea levels will also rise noticeably and temperatures across the world will reach record highs. These will be “colossal changes” according to Hugh. This will lead to up to 2/3 of the world’s population needing to move to try and escape these extreme changes. There is a “rapidly closing window to secure a liveable future”.

BUT WHAT CAN WE DO? HUGH SAYS WE NEED TO BEGIN TAKING RADICAL ACTION.

For those wanting to take greater steps toward saving the planet, Hugh recommends starting with the following ways:

Buddy up with like-minded people who want to make a change Exert your influence to get family & friends to also begin taking action Find a good carbon calculator to measure your personal footprint Make improvements in whichever areas you can, with emphasis on the more damaging areas like heating, food & transport. After making personal changes, shift your focus to your workplace

To finish on a lighter note, Hugh states that “we are the only generation that has ever had the chance to save humanity” and reminds us that yes, we CAN do it.

Tune in to this eye-opening assessment of our ever-changing climate with Hugh Montgomery & Liz Crowe.

For more like this, head to our podcast page

#CodaPodcast

James Anstey provides his thoughts on the recent developments in delayed cerebral ischaemia following a subarachnoid haemorrhage (SAH). Unlike TBI, where outcomes have plateaued after 20 years, outcomes have steadily improved for aneurysmal SAH. Early intervention, with an increasing amount of coiling as opposed to clipping as well as ICU all likely playing a part.

However, there is still a subsection of patients who deteriorate three days or more post their event. This is likely due to delayed cerebral ischaemia (as opposed to pure vasospasm). This is a diagnosis of exclusion in a patient who deteriorates after three days post bleed and without hydrocephalus, seizures, infection or another identifiable causal pathology.

There are several pathophysiological factors at play. Firstly, microcirculatory problems, including vasoconstriction in capillary beds and clumping with endothelial damage. This is perhaps why treatments to improve perfusion have had little success. Next, a combination of cortical spreading ischaemia and angiographic vasospasm.

Gold standard diagnosis of vasospasm remains the catheters angiography. Transcranial Doppler and CT angiography are both being used more and more and certainly have a role to play. CT angiography in particular stacks up reasonably well to catheter angiography and has a negative predictive value approaching 100%. One potential problem is overcalling the narrowing at times and has occasional artefacts. Transcranial Doppler is used occasionally however has challenges with reliable operators, is user dependent and only visualises a part of the cerebral circulation. 

Patients deteriorate, and we of course want to make sense of it. But what do we do thereafter? Hypertensive therapy with the aim to improve cerebral perfusion is often the go to method. James shares his thoughts on this technique, with reference to the current literature. Similarly, we diagnose vessel narrowing as the problem, however therapies that reverses this does not seem to confer good clinical outcomes. There is a large list of failed therapies because of this fact. 

This raises lots of questions about this patient group. Jame’s main messages are to not become obsessive with vasospasm, use CT angiography as a good substitute for catheter angiography and be cautious of vasodilator therapies as they generally do not seem to affect long term prognosis.

This #CodaPodcast was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting.

For more like this, head to our podcast page. #CodaPodcast

Peter Brindley joins you again to bring you The Great Re-Engagement, alongside Pelesa Motshabi Chakane, Silvia Perez-Protto and Andrew Shaw.

This episode explores the future of healthcare, and the ways to utilise the global community, research, and technology to enable greater contentment for clinicians to enable excellent healthcare at a global level.

What will successful medicine look like in 10 years’ time if we get it right? It is a daunting prospect to consider. Palesa hopes that the positivity that has been borne out of the Covid-19 pandemic continues. She believes it will be the capacity for the healthcare system to utilise the unity that has been exhibited over the last two years will be the driving force for ongoing positive change. Ideally, this leads to healthcare for everyone, prevention of sickness and disease and exceptional care for the whole person. Silvia speaks of her dream of the abolition of healthcare disparity and universal access for all.

Andrew hopes that the medical community will engage both science and art to make these dreams reality. Andrew speaks about the integration of technology into the practise of medicine and explores the potential benefits and disadvantages. Further he speaks to the changing nature of healthcare to be servicing customers as opposed to patients. This comes with greater choice for individuals accessing healthcare. He sees this “relationship based” healthcare as key to ensuring technology does not become all consuming.

Prevention, rather than cure, is a key tenant to the development of healthcare in Andrew’s opinion. This sentiment is founded on an agreement to a moral contract by the medical community. The moral contract contains within it a right to affordable and accessible healthcare for all.

Silvia feels poor data collection, especially in terms of underrepresented groups, is hindering the design and implementation of health care systems. The way forward is meaningful engagement with all patients to better design systems. Palesa provides a viewpoint from a system in lower income countries. Whilst the medium and high-income countries are faced with challenges surrounded by the rising use of technology and perhaps patient disengagement, Palesa makes the point that for most of the world, burden of disease is still the major challenge to be faced. Utilising technology in an appropriate way to bridge the gap between low- and high-income countries is the way forward

Balancing education, research and clinical care is another challenge that is becoming more and more apparent. Andrew thinks that clinical care is, and must be, at the forefront of medical practise. It is what the patients hold most highly and for good reason. Whilst education and research are important, these pursuits may be best to be left to those who are legitimately good at them. The team discuss the best ways to balance being pulled in multiple directions whilst keeping the patients at the forefront.

For more like this, head to our podcast page. #CodaPodcast

Climate change is a real and accelerating existential danger. Urgent action is required to halt its progression, and everyone can contribute. Pollution mitigation represents an important opportunity for much needed leadership from the health community, addressing a threat that will directly and seriously impact the health and well-being of current and future generations.

Inhalational anaesthetics are a significant contributor to healthcare-related greenhouse gas emissions and minimising their climate impact represents a meaningful and achievable intervention. A challenge exists in translating well-established knowledge about inhalational anaesthetic pollution into practical action.

This new guideline is designed to provide a platform that engages health professionals as an active learning community, and invites sharing of success stories and evolving solutions across varied global practice settings.

For this podcast, @GongGasGirl interviews @jessahegedus about how they did it and why it is important. 

This podcast was recorded for the Anaesthesia Journal.

For more like this, head to our podcast page. #CodaPodcast

In this episode of the #CodaEarth podcast about reducing harmful gases in anaesthesia, host Laura Raiti is joined by Jessica Hegedus - an anaesthetist working in Wollongong, New South Wales, who is also a member of Doctors for the Environment.

As someone passionate about environmental sustainability within anaesthesia, Jessica starts by telling Laura that the one thing that motivates her the most when it comes to the climate crisis is the fact that it’s an emergency that will end up impacting us all; as both citizens living in the community, and professionally as healthcare workers responding to its impacts. This puts many of us in the unique position in that we’re contributing to a crisis inadvertently as healthcare professionals, that we’ll also be on the frontline responding to.

They talk about the importance of reframing climate change as a health problem, and how as healthcare professionals we have the responsibility to protect and preserve health.

Jessica notes that while reducing healthcare admissions won’t resolve the climate crisis, that our leadership is essential, and that healthcare professionals are an important and trusted voice for action. She believes that we can send a powerful signal by getting our own house in order and that all contributions towards a low carbon society are important, however small.

Focus then shifts to the #CodaEarth Action – reducing harmful volatile agents used in anaesthesia - which not only make a significant contribution to CO2 healthcare emissions, but whose use is also directly within our control. Collective attention to reducing the impact is both meaningful and achievable opportunity for healthcare providers to demonstrate their leadership.

Laura and Jess also discuss six evidence-based actions to reduce anaesthetic gas usage that are practical and don’t compromise patient care. The actions include removing Desflurane from clinical use, de-commissioning Nitrous oxide piping, rationalizing Nitrous oxide where possible, advocating that healthcare workers use the lowest possible fresh gas flow, prioritising alternatives that have less environmental impact, and tracking progress, sharing results, and engaging with others.

Jess was inspired due to frustrations with slow progress on climate change, combined with increasingly visible effects of the crisis on the community and her practice, and has found that it can be both empowering and rewarding to exercise advocacy and effect change within her patch.

Jess also tells Laura that she believes there are meaningful actions we can all take that will contribute to a greater whole, and that the potential for healthcare providers to do this is immense. Jess believes that all contributions are meaningful and all roles are important, and that people shouldn’t be deterred by how big the problem is; perfect is the enemy of good and something is better than nothing.

Join Coda Earth now to safely reduce pMDI usage in your own practice.

In this episode of the #CodaEarth podcast, host Laura Raiti speaks to Brett Montgomery, a Perth-based GP &  senior lecturer at the University of Western Australia. As someone who is passionate about the climate emergency and the role each of us play in reducing the carbon footprint of healthcare, Brett is also the lead author of our Coda action plan to reduce usage of metered dose inhalers (pMDIs).

To kick off the podcast, Brett touches upon the fact that while much of society sees climate change as a political or environmental issue more commonly associated with polar bears and icebergs melting, he believes it’s important that we begin to see it as a huge public health issue to cultivate real change. Brett believes that by reframing it as an issue that has real and serious health consequences, it will ensure people who aren’t currently concerned by its effect are motivated to act when it comes to both climate change and their own health.

Brett then goes on to discuss in further detail his particular point of focus, which is the overuse of inhalers in healthcare. They discuss that while inhalers may appear to be a minor contribution to our impact as a whole when compared to the likes of aeroplanes and cars, in actual fact they have a disproportionate effect on health system’s carbon footprint.

In fact, the healthcare system in Australia contributes about 7% of our entire national footprint – so not an insignificant number - and within the 7% about a quarter is down to prescriptions, of which, a fair chunk can be attributed to these inhalers.

Laura and Brett then go on to talk about ways in which the Coda community can get involved, and Brett highlights that it’s important that everyone is more mindful about prescribing inhalers and that they employ critical thinking when it comes to ensuring that an inhaler is the right choice for both the patient and the environment.

They explore alternatives such as dry mist or powder inhalers, and consider a study that shows that between a third and a half of people who are prescribed these inhalers struggle to find evidence of the diagnoses.

Finally, they look at what the future could look like for Australia, should we work towards a collective movement against climate change, and discuss leading countries such as the UK and Sweden, both of whom are working towards eradicating overall health emissions.

To close, Brett shares his key piece of advice for those wanting to make change: the best climate action is what you’re good at, what you enjoy and what the world needs.

Join Coda Earth now to safely reduce pMDI usage in your own practice.

In this special podcast focused on the ‘Reduce Pathology Test Ordering’ step of the Coda Earth Action Agenda, host Laura Rati is joined by Forbes McGain. Forbes is an antitheist and intensive care physician who works at Western Health Melbourne and is also an associate professor of medicine at the University of both Sydney and Melbourne. He is passionate about making seemingly small, environmental financial and social sustainability changes to how we practise medicine, and is currently examining ways in which we can make hospitals more sustainable.

To open the podcast, Forbes and Laura discuss exactly what it is that makes Forbes most passionate about championing change when it comes to the environment.

Forbes credits two main driving factors – the first being that he is a strong believer that nature truly is extraordinary and delicate, and thanks to his childhood spent growing up on a farm - he’s really been close to nature, and he believes that loosing that would be deeply sad for people the world over. He also cites that as the father of two children, it’s really important that they get the chance to experience the things he has experienced in his life.

Forbes also touches upon the fact that climate change is just a single example of our overwhelming use of resources on the earth.

Forbes is a passionate advocate of Coda, and believes the global community of healthcare professionals are fantastic in exploring and taking the next step beyond research. He speaks to Coda’s ability to translate medical evidence and data to influence beyond the work practise of just one person.

When discussing how the Coda community can work collectively to make a huge impact on the environment, Forbes states that pathology testing – and the frequent overuse of these tests - is something everyone can be involved in; highlighting that millions of tests around the world can be reduced to lessen the environmental impact.

Laura and Forbes explore the unnecessary amount of atrial blood gas tests (ABG) that are done each year. They examine a hospital case which saw a third of over 65k blood gases performed annually ultimately deemed unnecessary. They consider the fact that everything healthcare professionals do has a carbon footprint, from a single pathology test right through to a new MRI scanner; meaning that reducing these tests has an impact on patients, finances and carbon footprint.

Finally, Forbes offers his advice to those who haven’t yet made climate change a priority, simply stating that educating oneself is the first step, and that while there are certain things you can do alone; there’s a lot more that can be done by collaborating with others.

Join Coda Earth now to reduce unnecessary pathology testing in your own practice.

In part 2 of this episode of the Coda podcast, Coda co-founder Roger Harris is again joined by Sydney-based Chris Anderson and Lausanne-based Frederic Michard, as they discuss how we can do better when it comes to deteriorating patients.

In part 1, the three intensive care specialists explored precisely what a deteriorating patient is, how big a problem they are and exactly why we should care – in this episode Harris, Anderson and Michard now look at ways in which the problem can be resolved.

Hosted by Roger Harris, he is joined by guests Frederic Michard - a Critical Care MD, PhD and Chris Anderson - a fellow intensive care specialist. Roger speaks to Frederic and Chris about ways in which healthcare professionals can recognise deteriorating patients sooner, and how they should be responded to, as well as discussing both solutions and how deteriorating patients can be better detected.

By way of a resolution, the three experts explore the idea of wearable, mobile solutions and – imagining the future of patient monitoring – they discuss what said solutions might look like, and how they will help nurses monitor deteriorating patients.

They also address the question that arises regarding which patients are most in need of monitoring, concluding that it’s those at the greatest risk of clinical deterioration.

Harris, Anderson and Michard also agree that there is reason to believe that new, future techniques will be able to ensure accurate detection of deteriorating patients, and that smarter software will make such a task more streamlined.

Michard finishes by noting the importance that healthcare professionals focus on individualising not only the monitoring that is on offer, but – equally important - precisely who is going to be monitored and when.

For more like this, head to our podcast page. #CodaPodcast

This podcast is sponsored by GE Healthcare.

In this episode of the Coda podcast, Coda co-founder Roger Harris is joined by Sydney-based Chris Anderson and Lausanne-based Frederic Michard, as they explore precisely what a deteriorating patient is, how big a problem they are and exactly why we should care.

Hosted by Roger Harris, guest Frederic Michard is a Critical Care MD, PhD, based in Lausanne, Switzerland, who trained in Paris University Hospitals and in Boston and is well known for his research work and publications, while Chris Anderson is a fellow intensive care specialist, also based in Sydney. Roger speaks to Frederic and Chris about why it is that many patients who are admitted to hospital for surgery end up staying due to complications, and the implications this has on both hospitals and nurses as a whole.

Also touched upon within the podcast is failure to rescue – or FTR – which is the failure or delay in recognizing and responding to a hospitalized patient experiencing complications from a disease process or medical intervention. They discuss the two main components – the failure to detect deterioration at an early stage and the failure to react appropriately and in a timely manner and the impact this can have on patients.

Addressing startling statistics – which suggest an alarming number of patients will die within 30 days of surgery - the three intensive care specialists pose the question: how do we better detect and monitor deteriorating patients?

They discuss everything from the unreliable recordings of respiratory rates to other inaccuracies that can impact both the treatment and detection of deteriorating patients, to the effect older patients on hospital wards are having on the complexity of cases and conclude that there is absolutely room for improvement regarding how patients are monitored.

Reflecting on the influence that Covid has had on hospitals, the three experts note that many health care systems are under strain in the post-pandemic world, and that the subsequent nurse shortages are a huge issue, particularly on hospital wards. They conclude that this too, is a reason to upgrade the way in which our patients are monitored.

For more like this, head to our podcast page. #CodaPodcast

This podcast is sponsored by GE Healthcare.

Following on from the Commit step episode, in which the Coda team discussed turning anxiety into action as a way to start bringing about change, host Dr Laura Raiti - who is both a paediatric oncology fellow, and a Coda team member – speaks to Dr Fintan Hughes, an anaesthesiology resident, about the next step we should be taking as a collective Coda community.

In this episode, Laura and Fintan start by discussing the urgent need to come together to bring about necessary change, which forms the basis for this step – which is to examine our behaviours and the impact they’re having on our own carbon footprint. They touch upon how using a carbon footprint calculator (such as the one on our website) is the first step when it comes to identifying areas in which we can do better by looking at our own personal footprint, and the importance of doing so, without feeling guilty.

From committing to change to examining where that change should start, the podcast explores the idea of flipping the script, and using the calculator to cultivate change and co-ordinated action.

Fintan also talks about how completing a fellowship at University College London inspired him to get involved with Coda; and how he thinks the entire Coda community can get involved to bring about maximum change.

From taking measures to becoming a more ethical shopper, to paying more attention to where you bank, Fintan examines seemingly small and easily accessible steps that every listener can take to make a huge impact on our carbon footprint.

Fintan also shares with listeners his key piece of advice for those who haven’t yet started taking climate action but want to help contribute to bringing about change, and explains how it’s the small things that can make a big difference.

For more head to our podcast page.

In the first episode of Coda Earth’s unmissable new podcast, listeners will hear Coda co-founders Roger Harris and Oli Flower discuss a wide range of topics from exactly how and why Coda came to be, to how each and every one of us can make small, simple, and actionable changes that will make a real difference to the planet.

Hosted by Dr Laura Raiti - who is both a paediatric oncology fellow, and a Coda team member - she speaks to Roger and Oli about just how easy it is to commit to change – and why it’s the first step toward more sustainable healthcare delivery. The three of them discuss everything from the pandemic, to the bigger issue of climate crisis, and exactly why it’s the biggest threat to global health.

They also touch on the fact that while many of us feel helpless as individuals, and that there is a real sense of anxiety in the community, that together, we can turn that anxiety into action.

From committing to adding your voice to the movement, to acting together as a community to have a real impact on our collective carbon footprint, the podcast explores the climate change actions heath care professionals can get involved with, on both a macro and micro level.

Coda is all about taking action wherever possible, and about making such action fun and enjoyable for the whole community, and ensuring both action and advocacy are accessible to as many people as possible. And so, in this podcast you can expect to hear practical pointers on exactly where to start, templates for each action which are very simple to follow, and a selection of simplified tips that really will make a difference. Designed for people at all stages of life, the tips will draw on expertise from all over the world and will give listeners the best possible starting point to make meaningful change.

For more head to our podcast page.

Catalina Sokoloff presents Milrinone for treatment of post-aneurysmal subarachnoid haemorrhage vasospasm (delayed cerebral ischaemia.)

Catalina firsts explains the pathophysiology of delayed cerebral ischaemia. She makes the point that there is still much we do not know. Probable mechanisms at the microcirculation level include release of free radicals, lipid peroxidation, cortical depression spreading and microthrombi formation.

The ideal treatment once delayed cerebral ischaemia is present is therefore unknown. Mechanical angioplasty seems to be favourable in some instances however has its shortcomings. As such it is often reserved as a rescue option. ‘Triple H’ therapy is intended to improve blood flow beyond constricted vessels; however, each component is flawed as Catalina explains. Intraarterial drugs have been tried however similarly, the evidence is lacking.

This brings Catalina to Milrinone. This drug is a phosphodiesterase 3 inhibitor that has vasodilating and inotropic properties. Relevantly, the cerebrovascular smooth muscle contains large amounts of phosphodiesterase 3, making Milrinone promising. The combination of increased cardiac output, alongside decreased afterload theoretically should increase cerebral blood flow and subsequently brain perfusion.

Milrinone has also been shown to be a potent anti-platelet aggregator as well as possessing anti-inflammatory properties. Both processes are likely involved in the pathophysiology of delayed cerebral ischaemia.

Catalina continues to discuss the trials (both animal and human studies) that look at the effect of this drug. Whilst there are still no randomised control trials (at the time of the talk) looking at Milrinone, the early retrospective trial data is promising.

There are of course still obstacles surrounding the drugs Namely, no standard dose, no guidelines regarding titration and concerns surrounding the vasodilating properties.

Catalina concludes by proposing the pros of this treatment as she sees it. She argues that the apparent improvement in mortality, the non-invasive nature, and the lack of haemodynamic compromise are all indicators of the potential future of the treatment.

Please note this episode was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting click here for more info.

For more like this, head to our podcast page #CodaPodcast

Communicating Science In A Pandemic (Pt. 2)

The power & presence that social media has in healthcare communication cannot be ignored. However, many are still reluctant to embrace its usefulness as a tool which can enhance education and patient connections.

IN PART 2 OF THIS PODCAST, DR JESSICA STOKES-PARISH CONTINUES TO DISSECT THE ROLE OF SOCIAL MEDIA IN SCIENCE COMMUNICATION, ALONGSIDE REGISTERED NURSES PENNY BLUNDEN (@sick.happens) & PATRICK MCMURRAY (@patmacrn).

The trio begin by addressing the negative tone that accompanies the topic of social media in the nursing community. Patrick explains how this perception should be abandoned and social media should instead be seen & used as an educational tool. Patrick integrates social media into his own role as a clinical educator and knows first-hand how effective it can be when used correctly.

The focus then turns to the importance on educating the educators. Patrick & Penny outline how medical educators must learn how to use social media to expand practice and connect with people. They can then demonstrate to their students how to use the social media tool responsibly, the same way they teach responsible use of stethoscopes or syringes.

Penny goes on to say that there is a need for greater support for nurses online, particularly with regulation. If online regulation guidelines are unclear, nurses can often become un-registered and simply give away unregulated information under the guise of being an “ex-nurse”.

PATRICK & PENNY THEN GIVE TIPS FOR ANY MEDICAL PROFESSIONALS WANTING TO UTILISE SOCIAL MEDIA FOR SCIENCE COMMUNICATION.

Penny highlights the importance of remaining authentic and not comparing yourself to others. This is the way to avoid “imposter syndrome”. She also says that it is essential to always have evidence to back up your claims. Patrick advises to not get caught up in follower numbers. Focus more on quality content and staying true to yourself.

Tune in to this unique, insightful take on science communication through social media with Jessica Stokes-Parish. Communicating Science in a Pandemic (Pt 2).

For more like this, head to our podcast page. #CodaPodcast

In Part 2 of this podcast Hugh Montgomery, Liz Crowe, and Shelly Dev along with Peter Brindley continue their discussion on wellness, resilience, burn out and being a healthcare worker in the world now.

IN THIS EPISODE THE TEAM DISCUSSES THE BROADER ORGANISATION STRUCTURE AND HOW THIS CONTRIBUTES TO (OR DETRACTS FROM) TEAMWORK AND HEALTHCARE WORKER WELLNESS AND SATISFACTION.

Shelly delves into the topic of the organisations and whether they are supporting the clinicians on the ground in the best possible way. Senior leadership, in her opinion, has done a major disservice to healthcare workers in their support and leadership roles. The support needed on the ground transcends yoga classes and healthy cooking recipes. Organisational support needs to acknowledge the needs and desires of healthcare staff, namely, to deliver excellent care and have good days at work in the context of a healthy life.

Liz suggests that although the organisational leadership is important for the overall wellbeing of the workforce, they are one aspect of a broader picture. She believes that leaders should be mentored in leadership. Teaching people basic communication and feedback skills would make a huge difference. Similarly, fostering a culture of togetherness and unity amongst separate entities of a larger organisation would lead to greater worker satisfaction and lead to better outcomes for patients.

HUGH RAISES THE POINT OF CLINICAL OUTCOMES BEING INFLUENCED BY ENGAGEMENT OF HEALTHCARE PROVIDERS BY SENIOR MANAGEMENT.

Management teams engaging with clinical staff seem to increase the patient care being delivered. Hugh provides his thoughts as to why this may be the case. Without senior management support, clinicians are increasingly overworked in a system that is constantly pushing back. This can, and does, lead to staff finally breaking and resigning on the spot.

The core the issue of healthcare worker burnout and dissatisfaction is simple Shelly states. In her view, everyone in healthcare at their core are good and decent people. They desire support and structures that allow them to enact this value in their everyday work. Although the solutions to the broad range of problems facing health systems across the globe are not as straight forward, remembering this fact is a good starting point. From here, the team provide some of their insights into the way forward.

Tune in to this authentic perspective on healthcare worker wellbeing with Peter Brindley, Hugh Montgomery, Liz Crowe & Shelly Dev. Overcoming the Great Resignation through Realisation: Part 2

For more like this, head to our podcast page. #CodaPodcast

This podcast is brought to you by Teleflex

This episode discusses the effect of the pandemic on healthcare professionals at an individual level, and how this has broad reaching ramifications at a team and industry level across different country contexts.

IN THIS PODCAST PETER BRINDLEY IS JOINED BY HUGH MONTGOMERY, LIZ CROWE, AND SHELLY DEV TO DISCUSS WELLNESS, RESILIENCE, BURN OUT AND BEING A HEALTHCARE WORKER IN THE WORLD NOW. THIS EPISODE EXPLORES JOB SECURITY, PUBLIC RECOGNITION, AND THE EFFECT OF THE PANDEMIC AT A PERSONAL LEVEL FOR DOCTORS AND NURSES.

In the context of the pandemic, the good comes with the bad – as Liz explains. Throughout the pandemic we have seen health care professionals experience trying work conditions the world over. However, it is one of the few industries that did not experience staff layoffs and work reduction. On the other hand, all healthcare systems in the world are imperfect. Throwing a pandemic into the mix produced even more challenges. It was therefore unlikely that the mental health and satisfaction from work was going to improve over the past two years.

Hugh discusses the disposition of healthcare workers in London during the pandemic – one of the hardest hit regions in the world. Whilst the pandemic initially provided an opportunity for intensive care doctors and nurses to do what they are trained to do; the ongoing nature has proven to be challenging. The doctors in his system are weary – both mentally and physically.

Shelly highlights the touching nature of working within a close team during this difficult period. In her experience there is a comradery that has been emphasised through the pandemic. However, Shelly states that even in non-pandemic times healthcare workers have struggled to cultivate a healthy relationship with the rest of their lives outside of work. Therefore, her first thoughts at the start of the pandemic were not of the intellectually interesting challenge, but rather what was going to happen with her family. On a broader scale, Shelly posits these hardships may lead to more and more healthcare professionals leaving the industry.

Tune in to this authentic perspective on healthcare worker wellbeing with Peter Brindley, Hugh Montgomery, Liz Crowe & Shelly Dev. Overcoming the Great Resignation through Realisation: Part 1

For more like this, head to our podcast page. #CodaPodcast

This podcast is brought to you by Teleflex

Communicating scientific information as a health professional is far more than just posting healthcare tips online. What can & can’t be posted? Who do we really listen to? And who is allowed to say what?

DR JESSICA STOKES-PARISH CHATS WITH REGISTERED NURSES & SOCIAL MEDIA PERSONALITIES PENNY BLUNDEN (@sick.happens) & PARTICK MCMURRAY (@patmacrn) ABOUT THE BARRIERS FACING HEALTH PROFESSIONALS WHEN COMMUNICATING WITH THEIR AUDIENCES ONLINE.  

Picking up where Professor Tim Caulfield’s “Great Rejection” misinformation podcast left off, Dr Jessica Stokes-Parish unpacks the challenge of communicating accurate information via social media as a health professional, specifically nurses. Penny Blunden and Patrick McMurray both have successful, widely-followed social media accounts which they use to provide useful insights into healthcare to mass audiences.

Jessica states how in recent years, including during Covid, she saw a rise in scientific misinformation across social networks. Whilst there was a strong presence of doctors attempting to de-bunk these myths, input from nurses seemed to be far less visible. This is why she recruited Penny & Patrick for some authentic perceptions of the relationship between science and social media.

Both Penny & Patrick outline how their own unique experiences as health professionals led them to use social media to provide more accurate, helpful healthcare information. The group explore the role & presence of nurses online and what kind of content resonates most with audiences. They also unpack how the perception of nurses as second-rate healthcare providers left them without a strong voice for a long time - which is why online accounts like Penny’s & Patrick’s are so vital.

THE TRIO THEN DIVE INTO THE KEY BARRIERS WHICH THEY FACE AS ONLINE INFORMATION PROVIDERS.

Challenges ranging from imposter syndrome & judgement from colleagues to social media policies & regulations are all investigated. Patrick states that existing on social media in a “helpful and meaningful way” must remain top-of-mind.

Tune in to this unique, insightful take on science communication through social media with Jessica Stokes-Parish.

Tune in to this unique, insightful take on science communication through social media with Jessica Stokes-Parish. Communicating Science in a Pandemic (Pt 1).

For more like this, head to our podcast page. #CodaPodcast

Nazih Assaad provides his expertise on the treatment of subarachoid haemorrhage. Treatment for aneurysmal subarachnoid haemorrhage (SAH) is an area that has had extensive research but not a great deal of success. Promising animal studies have not turned out as hoped in clinical trials and many questions remain unanswered. Nazih guides the listener through his approach on how to address the complicated presentation of SAH.

Firstly, subarachnoid haemorrhages can be graded clinically and radiologically. Clinical grades provide useful prognostic information, with poorer grades less likely to do as well as more favourable grades, despite best medical and intervention management. Nazih mentions the Fisher Scale which is useful for predicting vasospasm and how he integrates both into practise.

Moreover, these are the four areas he believes every clinician working in this space should consider with every patient presenting with a SAH.

The first is the effect of the haemorrhage itself on the patient. The sudden rise of intracranial pressure secondary to aneurysm rupture leads to dramatic clinical signs. These includes loss of consciousness and seizure like activity. There are no known agents to reverse the effects of the initial insult.

Secondly, managing the degree of hydrocephalus that most, if not all, patients will have if critical. Clinical hydrocephalus is treated with CSF drainage.

Thirdly, the prevention of re-haemorrhage is important. In bygone eras, patients with aneurysmal SAH did not have immediate management of the bleed. This has changed.

Finally, delayed cerebral ischaemia (usually relating to vasospasm) should be addressed. Gold standard of diagnosis is digital subtraction angiography, and following this, Nazih describes his aggressive management approach. 

Nazih takes the listener through what he considers the most critical aspects of managing a patient with an aneurysmal SAH. This talk explores diagnostic techniques, patient examination, surgical options, and other management considerations. He touches on the most recent guidelines and protocols around Australia and the world. 

Please note this episode was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting click here for more info.

For more like this, head to our podcast page #CodaPodcast

Whilst US medicine has always had issues, the pandemic sent the practice of medicine into a state of disarray.

DR JUSTIN HENSLEY DISCUSSES THE STATE OF US MEDICINE THROUGHOUT THE PANDEMIC. THE POWER OF INSURANCE COMPANIES AND DESPERATE WORKING CONDITIONS IN US HOSPITALS.

In this talk, Justin outlines the "idealistic" view he had of emergency care before working in the ED. However, he was not prepared for the “joyless” nature of a medical system which seemed to place profits above patients. 

Through a detailed account of what it’s like to work in the US healthcare system, Justin shares his belief that US medicine is “purely, 100% a business”.

He dives into the unavoidable financial struggles that patients must endure with private insurance companies for even the most basic care. Justin states that, at times, it felt as though he was just “generating a bill for the patient”.

Venturing further into the issue of insurance companies, Justin takes us through his own experience of delivering healthcare to rural Americans. His patient-first philosophy led this project, only to have it shut down due to insurance companies not recognising the importance of his work.

He explains how fear at the beginning of the pandemic saw ED patient numbers drop, meaning less cashflow and dramatic cutting of shifts. Once the patient volumes went back up, staffing failed to appropriately match the new demand. This lead to a burnout-fuelled “logistical nightmare”.

Finally, Justin outlines how “embracing the suck” led him to move to Australia to pursue his current endeavour. He has reignited his passion for providing much-needed healthcare to rural patients.

Tune in to this fascinating take on international healthcare with Dr Justin Hensley. Healthcare Wellbeing: Knowing when it's time for a change

For more like this, head to our podcast page. #CodaPodcast

In part 2 of The Great Rejection, Peter Brindley and Tim Caulfield return to continue their discussion of misinformation in the world of health science. This episode examines how to teach the public to think critically, how to deal with uncertainty as a clinician and how to better understand the pros and cons of transparency.

Tim suggests going back to first principles and reinforcing to the public that science is a process. Secondly, Tim highlights how basic educational tools can make a big difference when teaching the public to cut through the noise. Moreover, creating engaging content with accurate messaging can help turn the tide on misinformation in the public realm.

This brings Tim and Peter to the idea of uncertainty and how it sits with the public. The research suggests that the public wants the scientific community to be honest about uncertainty. Reassuringly, the same research tells us that by being honest, an institution or medical body does not lose any credibility. Tim points out the incredible uptake of mask wearing in some countries. This is despite misinformation being disseminated online, an indication of the willingness to acknowledge uncertainty and still act in accordance with advice.

Whilst transparency is positive on its own, it may not achieve the aims originally intended. Tim highlights public reactions to literature retractions, medical debates, and conflicting results as an example of scientific transparency being counterproductive. However, that is science! And it is messy – as such it does not always lead to good, especially in the short term. However, Tim contends that whilst the ‘backfire effect’ (the negative ramifications of debunking scientific claims) exists, the real-world implications are small. Therefore, scientists and medical professionals should not worry too much about retracting or debunking previously established evidence.

Finally, for more like this, head to our podcast page #CodaPodcast

For more on Tim Caulfield, click here.

Please note this episode was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting click here for more info.

Oli Flower gives us a preview into the future of traumatic brain injury (TBI) management. It is late in the 21st century and a man suffers a TBI. Oli describes the on scene immediate management of this patient. Drones and closed-circuit cameras combine to provide the closest ever trauma centre, taking tissue samples and patient images. Not only that, but the samples have been analysed and referenced against a huge database, providing the awaiting critical care clinicians with an individualised and effective treatment plan for each patient.

To develop the technology that Oli envisages, we need to collect more information in the right way. Ultimately, the future of TBI management requires the development of tools to apply masses of information to the patient in a meaningful way.

One such was to achieve this, is by using biobanks. A biobank is a repository of human tissues and samples with the corresponding appropriate and correct annotating data. Specifically, for TBI this primarily means blood and CSF. The tissue is annotated with prognostic information and patient centred long-term outcome data from its donor, allowing a huge pool of information that can be accessed to inform treatment moving forward.

Evidently, the potential for a biobank is enormous. Oli describes rapid genomic assessment, proteomic analysis and metabolomic profiling as potentials in the near future. This data would provide a plethora of information per patient. This does however, pose a challenge, and leads to the need for advanced computer processing to interpret the data, whilst being able to factor in the dynamic and evolving processes that define critical care. Artificial intelligence no doubt has a part to play.

Biobanks have started to be developed across Australia and the world. However, they requires a massive collaboration that spans across countries. In doing so, we can strive towards the future treatment of TBI.

Finally, for more like this, head to our podcast page #CodaPodcast

Peter Brindley and Timothy Caulfield answer the big questions around how science and health are represented in the public sphere.

What is science? When do we accept it and when do we reject it? The representation of science and medical information on social media has erupted in recent times – in large part thanks to the Covid-19 pandemic. Along the way, misinformation has come to the forefront. Why do people believe misinformation, where does it come from and what damage is it doing?

These questions are not new, however in the modern world (pre- and post-Covid) they are in the public conversation more than ever. Tim believes that the spread of misinformation is one of the greatest challenges of today – sparking an ‘Infodemic’. The ideological nature of misinformation has also grown in recent times. Whilst Tim contends that it has always been there, it has become more dominant with the ever-growing popularity of social media.

Social media is not going anywhere. As such, we must learn to live with it, and employ its use in such a way to be proactive and productive. Tim talks to the positives of social media, in particular its ability to decrease feelings of social isolation as well as its entertainment and information value. However, the current information environment rewards extremism, polarisation, and the spread of misinformation.

As Tim explains, it is all the above.

How can healthcare professionals move towards a positive use of social media?  Tim believes engagement is constructive and he favours healthcare professionals and peak medical bodies being on social media.

Finally, Tim addresses the shifting landscape when it comes to healthcare engaging on social media. Tim believes that clinicians can (and should) share valuable content online.

For more like this, head to our podcast page. #CodaPodcast

Reuben Strayer and Duncan Grossman discuss all things airway. Specifically, how the introduction of many airway technologies at once–some of them revolutionary, some not–have confused our airway strategy. So how can we incorporate the best of these technologies into contemporary airway management? They begin with a big question – what equipment should you choose?

There are many options, including direct or video laryngoscopy as well as multiple versions of the laryngoscope blade itself. As Reuben explains, all these terms can be confusing and are often imprecise.

Direct laryngoscopy clears a line of sight between one’s eyes and the glottis to visual it. This is unlike video laryngoscopy which uses a camera to visual the glottis. The next distinction is the type of blade – standard geometry versus hyperangulated blades.

The differences between - and the varying uses of – standard geometry blades and hyperangulated blades are discussed. This discussion will clear up confusion about the nomenclature for all clinicians. The long and the short of it is that a camera can be attached to both standard geometry and hyperangulated blades allowing video laryngoscopy with both. It depends on the clinician’s comfort and training as to which one you will reach for.

However, using a hyperangulated blade does make viewing the cords easier. The hyperangulated blade also requires less force, which is favourable in instances of cervical spine injuries or tongue masses. But, there are downfalls, and Reuben takes us through what to expect.

The standard geometry blade on the other hand is faster, and easier to utilise suction. It is also easier to use a bougie when using a standard geometry blade. Moreover, the standard blade video laryngoscopy uses the same skill set as a direct laryngoscopy and this is beneficial for new learners.

Reuben contends they should for a few reasons. The first being that technology is fragile and can let you down at any moment. The second being that standard geometry video laryngoscopy contains within it the older technique – just with the addition of a video. Therefore, the way to get good at direct laryngoscopy is by getting very, very good at video laryngoscopy.

Jump onboard and join Reuben and Duncan as they provide a masterclass on airways.

For more like this, head to our podcast page #CodaPodcast

Please note this episode was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting click here 

Terry O’Brien presents the evidence and recommendations around the use of continuous EEG. EEG is an old technology, first introduced clinically in the 1920s. As we move deeper into the 21st century, Terry argues that this technology should be brought to the forefront in ICUs around the world. 

EEG works in a simple manner. Electrodes are placed on the scalp, measuring the potential difference between two points, and displaying the trends over time. EEG has a high resolution, providing information that no other investigative modality can provide.

How does this apply to intensive care? Continuous EEG (much like continuous ECG or oxygen saturation monitors), Terry insists, has a place in the monitoring of critically ill patients. It exists as the best way to diagnose a seizure and can provide information regarding treatment effect. Moreover, EEG gives real time information about depth of sedation and prognostication.

Although EEG is standard care in ICU in the United States, Australia is lagging behind. Patients frequently seize in the ICU, particularly after a brain insult or injury. To make matters more complicated, these patients are often sedated, and hooked up to ventilators and other monitoring equipment. This makes the seizure hard to appreciate. 

If seizures are unrecognised, the treatment cannot be targeted. This leads to under or over treatment. Terry likens treating seizures in the ICU without EEG monitoring to treating cardiac arrhythmias without an ECG.

Depth electrode recording (in addition to scalp electrode recordings) have been used with interesting results. Looking harder proves to find more seizure activity with the more intense monitoring. Terry describes this as the tip of the iceberg. Does the rest of the iceberg matter? Seizures have been correlated with increased mortality. Seizures may be a prognostic marker in patients with brain injury. There may also be severe long-term morbidity in those patients who experience prolonged non-convulsive seizures in the ICU.

Randomised controlled trials are difficult to perform in this group due to difficulties with ethical questions. This means the majority of evidence is circumstantial. With that being said, the evidence seems to suggest the in-hospital mortality is less for certain populations with the use of continuous EEG without adding significantly to length of hospital stay. Experimental data also shows promise, as Terry explains. He elaborates on the most recent studies looking at continuous EEG.

Who should get continuous EEG, and how should it be used. Terry proposes the continuous EEG be used in the diagnosis of non-convulsive seizures and the treatment of non-convulsive seizures in the comatose patient – especially in the first 48 hours. Similarly, the use of EEG should be prioritised in patients with a history of seizures. In doing so, Terry believes that ICU patient outcomes and survival will be increased.

Please note this episode was recorded in November 2018 as part of Brain, a CICM Neuro Special Interest Group meeting.

Alex Rowell, Fahad Ashraf, Greg Selkirk & Luke Torre continue their discussion stroke management. In this talk they tackle imaging and treatment of stroke, including mechanical thrombectomy.

Imaging is an enormous part of the process of stroke management. It is critical for diagnosis and stratifying patient treatments.

The first imaging modality to order is a non-contrast CT head. As Greg explains, not everyone with neurological symptoms has an ischemic stroke. Other diagnoses to consider include Todd’s paresis and intracranial haemorrhage. The CT will also inform the clinician how much established infarct is present and give an indication of where the clot is.

Moreover, carotid angiogram should be used to assess the intracranial vessels. It also allows one to plan the fastest way to remove a clot, should it be present. Transradial and transfemoral thrombectomy are two options. The imaging provides the clinician with valuable information about the most efficient and fastest way of reaching the clot for removal.

Lastly, the team discuss CT perfusion. A word of warning. This exists as a problem-solving test. It is a good idea to interpret with caution!

Where CT scanning is available, this modality combined with a thorough history and assessment of deficits can lead the clinician towards the most appropriate treatment options – including thrombolysis.

The question then becomes, does the use of thrombolysis in a rural or remote location preclude the eventual use of thrombectomy? As Greg explains, thrombolysis works well in conjunction with thrombectomy. Receiving thrombolysis does not preclude the use of thrombectomy and does offer advantages.

Furthermore, Greg will provide a detailed description on the procedure of thrombectomy, including the various methods used and the care of the patient after a thrombectomy. He touches on the use of general anaesthesia during the procedure, as well as antiplatelet therapy post-intervention.

Thrombectomies are not without risks. Complications include perforation of blood vessels. From a neurological perspective, Fahad describes the use of repeat scanning to ensure the absence of any subsequent bleeding and the implications for ongoing medical therapy.

Finally, the discussion concludes with a broader take on stroke services in general. This includes pre-hospital stroke awareness in the community, post stroke rehabilitation and neuroprotection measures.

For more head to our podcast page #CodaPodcast

Please see the webpage for the images referred to in this talk. 

In this podcast, Alex Rowell, Fahad Ashraf, Greg Selkirk & Luke Torre review stroke management in 2022. Stroke management has changed dramatically in the last 10 years.

In 2015, we proved the efficacy of mechanical thrombectomy. In 2018, we established evidence for mechanical thrombectomy beyond 6 hours in patients with favourable imaging. Moreover, there has been extensive research into dual anti-platelet therapy to prevent recurring stroke in minor stroke patients.

From a technical point of view, there has been an explosion of the number of suction catheters and stent retrievers on the market. This has made mechanical thrombectomy safer & has allowed us to chase distal clots.

So in 2022, it is not just that we are doing thrombectomy, but… we are doing it better.

Next, Fahad & Greg discuss what the patient journey looks like in 2022 from being out in the community, to receiving treatment. They discuss how we have streamlined the process - including creating general awareness of stroke in the public, implementing screening tests like FAST & coordinating with emergency first responders.

The challenge in modern day stroke treatment is how to determine which patients get thrombectomy, which patients get thrombolysis & which patients are given conservative treatment?

Greg Selkirk suggests that there are five main factors:

Does the patient have severe cognitive impairment (what is their pre-existing quality of life?) What is their functional status? Where is the location of the clot and what is the risk of removing it? What symptoms does this patient have? Do the symptoms justify the risk? How much salvageable parenchyma is there?

Tune in to a #CodaPodcast by Alex Rowell, Fahad Ashraf, Greg Selkirk & Luke Torre. An informative & interesting update on stroke management in 2022.

Finally, for more like this head to our podcast page #CodaPodcast

In the Emergency Management of Chronic Pain podcast, Duncan Grossman and Reuben Strayer discuss how and why patients with chronic pain present to the ED.

Managing patients with chronic pain is challenging and often it feels like these patients present to the ED during every shift. But… is it as common as it feels?

Statistics suggest that 20% of American adults suffer from chronic pain.

Opioids are effective for managing acute pain. However, when they are used for (even) more than a couple of days they can start to cause pain.

Reuben and Duncan discuss a framework that accounts for the relationship between chronic pain and opioid use. Noting that each patient presents a unique challenge.

Take for example, the patient who is on daily, low dose opioids but is otherwise unaffected by their pain medication.

Or, the patient who has chronic pain but doesn’t take opioids. We need to be careful here as these patients can be more susceptible to developing an addiction from prescribed opioids due to their ongoing pain.

What about the patient who takes opioids daily but is buying them off the street...

Reuben takes us through some strategies for helping all of these patients. One such strategy is to talk to the prescribers. We need to help these patients by encouraging their prescribers to take the reins and to move the needle from opioid harm to opioid benefit.

Tune in as Duncan Grossman grills Reuben Strayer on chronic pain in patients, how to manage them and how to help them.

For more like this, head to our podcast page #CodaPodcast